Strong Calves, Steady Bodies

by Julia Glick, PT

Whether we've tripped over an unexpected item in our home or over our own feet walking down the sidewalk, nearly all of us have taken a tumble - and those risks only increase for older adults. In fact, up to one third of people over 65 will have a fall each year (Sherrington et al. 2016), so balance and fall prevention is a huge part of what we look at in the clinic. Since there are already many resources that discuss the negative impacts of poor balance and falls - especially in the elderly - let's focus on balance and its relationship to calf strengthening.

But first, how do we define balance? According to a 2012 Cochrane review, balance is “the ability to stay upright and steady when stationary and during movement.” Let's break that down a little bit: if you are walking, sitting, standing, running, or even juggling balance is your ability to stay upright. If you start losing your balance or falling, balance also includes the ability to return to the upright position. It is thought that balance declines with age for a variety of reasons such as decreased strength, range of motion, reaction time, and awareness of where the body is in space (proprioception) (Howe et al. 2012).

Naturally, there are a number of interventions to help patients improve their balance. In a 2016 study by Maritz and Silbernagel, patients were given a general balance training program, but what was novel about it was that it incorporated calf strengthening. The researchers found that the group that incorporated single leg calf raises over 5 weeks into their program had greater improvements in balance than the group that did not. But why would doing calf raises make someone’s balance better?

A study conducted by Fujiwara et al. (2011) helps shed some light on why calf strengthening may help with balance. In this study, participants performed 100 calf raises daily for 2 months. They showed improved strength of the soleus (part of the calf) and improved reaction time with reaching activities. Fujiwara et al. suggested that calf strengthening promoted these improvements by promoting an "ankle strategy" with balance. Calf strengthening has the potential to improve someone’s ability to react quickly with small ankle movements and other postural muscles to prevent the need to take a big step if someone loses their balance. A smaller movement requires less energy and decreases the chances of someone stepping wrong and getting hurt. 

Single leg calf raises

Double leg calf raises

If you are already working on a balance program try adding double leg calf raises to your program and if those are too easy try single leg calf raises. If you are having difficulty with your balance or are having falls please contact a medical professional.

References: 

Fujiwara, K., Toyama, H., Asai, H., Yaguchi, C., Irei, M., Naka, M., & Kaida, C. (2011). Effects of Regular Heel-Raise Training Aimed at the Soleus Muscle on Dynamic Balance Associated With Arm Movement in Elderly Women. Journal of Strength and Conditioning Research, 25(9), 2605–2615. doi: 10.1519/jsc.0b013e3181fb4947

Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD004963. DOI: 10.1002/14651858.CD004963.pub3

Maritz CA, Silbernagel KG. A prospective cohort study on the effect of a balance training program, including calf muscle strengthening, in community-dwelling older adults. Journal of Geriatric Physical Therapy 2016; 39:125-131.

Sherrington C, Tiedemann A, Fairhall NJ, Hopewell S, Michaleff ZA, Howard K, Clemson L, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD012424. DOI: 10.1002/14651858.CD012424

Happy National Physical Therapy Month!

As the weather cools in the fall, it’s tempting to be less physically active. October is the perfect time to stay focused on healthy self-care because we’re celebrating National Physical Therapy Month! Find new ways to get your body moving. Whether you’ve felt intimidated by yoga, you’ve always wanted to play tennis, or you’re finally ready to sign up for that 5K race, this month may be the perfect time to push yourself just a little out of your comfort zone. Your physical therapists at Lakeshore Physical Therapy are here to support you! Choose more movement. Choose better health. Choose physical therapy.

Elbow Pain, Could the Shoulder be to Blame?

by Julia Glick, PT

As therapists in a clinic located inside of a large tennis club, we are seldom surprised when a number of our patients each year present with lateral epicondylitis – or, as it is more commonly known, tennis elbow. Lateral epicondylitis pain usually occurs over the outside of the elbow where many of the forearm muscles attach, an area that experiences a lot of strain in tennis. However, even those of us who aren’t on the courts every week should be aware of it: it is also common in people who spend a lot of time at the computer or perform lots of gripping during their day. 

Despite the fact that lateral epicondylitis pain feels like it is centered in the elbow, it is important to look at the whole arm. Many people who come to us for tennis elbow have unsuccessfully tried exercises on their own that focus on the wrist and elbow, and are surprised when we turn our attention to the shoulder. Most specifically, the muscles that control shoulder blade position, such as the lower trapezius and serratus anterior, are crucial when treating the elbow, as the position of the whole arm is determined by the orientation of the shoulder blade. 

In fact, several research articles have come out in the past few years that focus on the role weakened shoulder blade stabilizers plays in lateral epicondylitis. Lucado et al. and Day et al. found that people with lateral epicondylitis had significantly weaker lower trapezius and serratus anterior musculature than people without any lateral elbow pain. In a case study performed by Bhatt et al., the research team only treated a woman’s shoulder blade stabilizers and were able to resolve her lateral epicondylitis. Essentially, these studies agree that the muscles that help pull the shoulder blade back and keep it stable also control the position of the arm and elbow: when it comes to prevention of elbow pain, shoulder blade strength and position matters.

Interested in finding some exercises that target the lower trapezius and serratus anterior to help maintain the shoulder blade in its optimal back position? I’ve included some below:

Easier Lower Trapezius

Lie on stomach and roll up a small towel under forehead and place hands on back of head/neck. Squeeze shoulder blades back and down toward opposite pants pocket and lift up elbows. Hold for 5 seconds and perform 5-10 repetitions.

Harder Lower Trapezius (Y)

Lie on stomach and roll up a small towel under forehead. Lift your arms up so they make a “Y” shape. Squeeze your shoulder blades back and down toward opposite pants pocket and lift your arms. Hold for 5 seconds and perform 5-10 repetitions. 

Serratus Anterior Wall Slides

Put your forearms on the wall and push your shoulder blades apart and into the wall. Keep this pressure into the wall and slide your arms up and down. Perform 5-10 repetitions.

Try these exercises and let us know what you think! If you do have pain that is persistent, please stop by to speak with one of our skilled clinicians, who can help you with your injury.

Resources: 

Bhatt, J., Glaser, R., Chavez, A., & Yung, E. (2013). Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report. Journal Of Orthopaedic & Sports Physical Therapy, 43(11), 841-847. doi: 10.2519/jospt.2013.4659

Day, J., Bush, H., Nitz, A., & Uhl, T. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 45(5), 414-424. doi: 10.2519/jospt.2015.5290

Lucado, A., Kolber, M., Cheng, M., & Echternach, J. (2012). Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 42(12), 1025-1031. doi: 10.2519/jospt.2012.4095

The Home Stretch

by James Bansberg, PT

Some of the most common advice we receive when we complain about a newly discovered ache or pain is to just “stretch it out.” But what does that even mean? How long do I hold it? When should I do it? Do I just throw my leg up on a table for a couple of seconds and beg the pain to go away?

Most of what we know about stretching is either a myth or based heavily on outdated science. Worse yet, when speaking to various health professionals, their recommended duration for stretching can vary greatly, which can be confusing and sometimes discouraging for their clients. Luckily, a 2018 study by Thomas et. al has helped answer some of these questions. The study focused on most effective form of stretching for improving range of motion, as well ideal stretch duration and frequency.

Despite its vilification in recent media, the researchers found that static stretching was more effective than other forms of stretching for improving range of motion long term. This doesn’t mean that static stretching should be the only form of stretching utilized in a regular workout program, however. Other studies have discovered the benefits of other forms such as dynamic and ballistic stretching, especially prior to activity.

As for duration, there’s good news for the more impatient types: a 30-60 seconds hold was as beneficial as other, longer durations (60-120 seconds and over 120 seconds). Consistency, however, was key: the research showed stretching more than 5 times a week was more effective than 2-3. Interestingly, 7 days of stretching per week did not yield better results than 5 days, making the sweet spot between 5-7 days per week.

The final portion of the study looked at optimal time spent per week stretching to maximize mobility changes. Surprisingly, a minimum of 5 minutes was required for significant changes, with the ideal time being anywhere between 5-10 minutes.

Ultimately, some stretching is better than no stretching, and recent studies have found benefits to other forms of stretching as well as foam rolling. However, even stretching has a proper dosage, so it is important we utilize available evidence to guide our decision-making so that we are able to reap the greatest benefit. 

References: 
Thomas E., Bianco A., Paoli A., Palma A. The Relation between Stretching Typology and Stretching Duration: The Effects on Range of Motion. Int. J. Sports Med. 2018;39:243–254. doi: 10.1055/s-0044-101146.

Staying (David) Wise on the Slopes

By Jill Jonda, PT

The 2018 Olympic games have come and gone! As we sat in front of our television screens, watching elite athletes perform with skill, speed, and drive to win, a lot of us tend to want to get out there and try to channel our own Olympic skills. As we saw athletes like Mikaela Shiffrin, Lindsey Vonn, and David Wise swiftly ski down a slope or half pipe without missing a beat, we may have thought, “I can do that!” Those athletes make complex arduous maneuvers look effortless. Unfortunately, when people who may not be as skilled try things that Olympic athletes make look so easy and natural, we tend to see more injuries. Before you hit the slopes, it’s important to be aware of common injuries and how to prevent them.

Because of the structure of the ski boot, the angle it puts on the knee, and of course the variability in the terrain of the snow, one of the more common body regions injured while skiing is, in fact, the knee.  Some of the most common knee-related injuries associated with downhill skiing include medial collateral ligament (MCL) sprain, anterior cruciate ligament  (ACL) sprain or tear, and meniscus tear. An injury to all three of these areas is often referred to as the “unhappy triad.”

That may sound pretty intense, but it’s no reason to cancel your trip and try to get your deposit back on your skis and helmet. If you want to have a good time and avoid the risk of injury, follow these steps listed below:

First, you want to understand your skill level.  All too often injuries occur because we end up doing too much too soon and get ourselves into quite a pickle.  If it’s your first time out in a while, take it easy and stay on the easier hills. Better yet, schedule a training session with one of the professionals and get a tune-up on your skills.

Second, it’s always important to warm-up before any type of physical activity, and is especially important for a demanding activity, such as downhill skiing.  A dynamic warm up will help to increase blood flow, prepare the nervous system for increased activity, and improve overall range of motion which all helps to reduce the risk of injury.

Third, it’s important to strengthen key muscles that help prevent aberrant movement of the knee. The hip abductor muscles (specifically, the gluteus medius muscle) help to stabilize the pelvis when weight is shifted onto one leg, which, in turn, prevents inward and torsional stresses on the knee.  If the femur bone becomes internally rotated and adducted (or “knock knee”), this causes a valgus force at the joint, which is the setting of most of these knee injuries. In the same way, the abdominal musculature is also essential in maintaining control and stability while skiing.  A strong core can help to block too much trunk displacement over one leg if you happen to “catch an edge” or lose your footing over a patch of ice and can prevent a fall.  Strong quadriceps and hamstring muscles also assist in demonstrating proper knee joint mechanics, especially as you squat closer to the ground to pick up speed as you ski down the slope.

Here are some options for strengthening exercises you can try before your next ski adventure:

Remember to always be safe and know your limits if you want to stay injury-free on the slopes.  If injury does occur, however, go see your physical therapist!